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week 65 > Crown Endo Treated Teeth-Dr. Serag > Flashcards

Crown Endo Treated Teeth-Dr. Serag Flashcards

1
Q

What is the purpose of adding a Post to endo teeth?

A
  • Only helps retain the core
  • DOES NOT strengthen the tooth
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2
Q

Why are endo treated teeth different?

A
  • Loss of Sensation
  • Physical Properties
  • Loss of Structural integrity
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3
Q

Loss of sensation

A
  • No protective feedback to pain
  • Maintain proprioception ONLY
    • sense of position and movement
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4
Q

Altered Physical Properties

A
  • Loss of hydration/moisture
    • no effect on physical properties
  • Reduced strength
    • slight reduction in hardness
  • Mechanical properties
    • no reduction
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5
Q

Loss of Structural Integrity

A
  • Due to loss of tooth structure from
    • caries
    • fracture
    • endo procedure
  • Have greater possibility to fracture
  • reduced stiffness
  • main reason why endo teeth are weakened
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6
Q

What are 2 factors to consider when restoring an endo treated tooth?

A
  • Functional load on the tooth
  • Remaining tooth structure
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7
Q

Tx Planning :Functional Load on the tooth

A
  • tooth position
    • anterior or posterior
  • Single crown or RPD or FPD abutment
  • Opposing dentition
    • natural tooth vs removable prosthesis
  • Parafunctional habits
    • bruxism
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8
Q

Tx Planning: Remaining tooth structure

A
  • Class 1:
    • most favorable prognosis
    • remaining tooth structure is enough to support crown w/o post
  • Class 2:
    • more loss of coronal tooth structure
    • needs post to retain core
  • Class 3:
    • significant loss of coronal tooth structure
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9
Q

Anterior Teeth Treatment Options

minimal vs significant coronal damage

A
  • Minimal Coronal Damage
    • Intact tooth (except small access opening)
      • greater strength against fractures
    • or small proximal lesions/restorations
    • Tx: simple direct restoration
  • Significant Coronal damage
    • Extensive coronal destruction
      • large proximal caries/restorations and unsupported enamel
    • Tx:
      • Post & Core and Crown
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10
Q

Anterior Teeth Treatment Options

minimal vs significant coronal damage

A
  • Minimal Coronal Damage
    • Intact tooth (except small access opening)
      • greater strength against fractures
    • or small proximal lesions/restorations
    • Tx: simple direct restoration
  • Significant Coronal damage
    • Extensive coronal destruction
      • large proximal caries/restorations and unsupported enamel
    • Tx:
      • Post & Core and Crown
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11
Q

Posterior Teeth Treatment Options

minimal vs significant coronal damage

A
  • if not crowned, significant increase in mechanical failure
  • Minimal coronal damage
    • intact tooth
      • small access opening
    • Tx:
      • crown after sealing access hole (Different than anterior)
  • Significant Coronal Damage:
    • Extensive coronal destruction
      • large proximal caries/restorations and unsupported enamel
    • Tx: Post & Core and crown (same as anterior)
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12
Q

Ferrule Effect: Define

A
  • height of tooth structure from core margin to crown margin
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13
Q

What is the latin meaning of Ferrule

A

Iron Bracelet

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14
Q

What is the ideal measurement for Ferrule?

A

1.5-2mm

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15
Q

W/out ferrule

A
  • Greater chance of mechanical failure of restoration (crown)
  • all the forces that the crown is subjected to is transferred to the core-→post inside the root
    • very tip of post=stress area→root fracture
  • Low prognosis
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16
Q

What are your 3 options when no ferule effect is present?

A
  • Ortho extrusion of the root
  • Surgical Crown Lenghtening
  • Extract & Implant placement
17
Q

What are the disadvantages of Ortho extrusion of the root due to no ferrule effect

A
  • Expense
  • More time for treatment
18
Q

What are the disadvantages of Surgical Crown Lengthening due to no ferrule effect

A
  • Anterior teeth
    • poor esthetics
    • “Longer tooth”
  • Posterior Teeth
    • not possible if furcation exposure is expected
  • alter crown/root ratio
19
Q

What are the disadvantages of extraction and implant placement due to no ferrule effect

A
  • lose a natural tooth
  • implants require more maintenance
20
Q

What is something you should never do to gain ferrule effect?

A

Never Violate Biological Width:

  • Subgingival margins-violate biological width
    • causes inflammation
    • results in recession
  • Crown Lengthening should be done when you expect to invade the biological width
21
Q

Classification of posts are based on:

A
  • fabrication method
  • material
  • shape
  • presence of threads
22
Q

Posts: Fabrication Method

A
  • Prefabricated posts
    • Provided as:
      • Metallic or non-metallic
        • metal
          • titanium
          • stainless steel
        • Non-metal
          • fiber
          • zirconia
      • Parallel vs tapered
      • Threaded vs Non-threaded
        • threaded: can be tapped
        • non-threaded: only depend on cement for retention
      • Serrated vs Smooth
        • serrated:better retention
    • given a drill system to enlarge and shape canal
    • after post is cemented the core is built w/a core material
      • amalgam
      • composite
  • Cast “Custom” Post & Core
    • provided as cartable plastic post pattern
    • core is built using wax or pattern resin
    • then cast into metal
23
Q

Advantages and Disadvantages of Prefabricated Posts

A
  • Advantages:
    • ease of use
    • less appointments needed
  • Disadvantages:
    • weak bond b/w the post and core
24
Q

Advantages and Disadvantages of Cast “Custom” Post and core

A
  • Advantages:
    • core and post are one piece
    • minimmizes failures
  • Disadvantages
    • more expensive
    • requires at least 2 appointments
25
Q

Posts based on material

A
  • Metallic Posts:
    • Prefabricated
      • titanium
      • stainless steel
    • Cast
      • Semiprecious alloy
  • Non-metallic posts: Fiber (Fiber Glass) or Zirconia
    • Fiber Glass
      • flexible post
      • same flexibility as dentin
      • no root fracture
    • Zirconia
      • very stiff
      • used w/Emax
      • pressable ceramic fired to it
26
Q

What are advantages and disadvantages of Metal Posts

A
  • Advantages:
    • High strength
  • Disadvantages:
    • color
      • can’t use w/full ceramic crowns
27
Q

What are advantages and disadvantages of Non-metallic Posts:

A
  • Advantages:
    • Esthetics
      • can use w/full ceramic crown
  • Disadvantages:
    • Fiber-Losses its retention
      • its flexibility breaks the cement line
    • Zirconia-stiffness
      • impossible to retrieve
28
Q

Posts based on shape:

A

Parallel vs Tapered posts

  • no difference in failure loads
  • Parallel Posts:
    • Prefabricated or Cast posts
    • Lower failure rate
    • Most failures due to cementation failures
  • Tapered Posts:
    • Prefabricated or Cast posts
    • Higher failure rates
      • due to wedging actions
    • Most failures due to root fractures
      • leave teeth unrestorable
30
Q

What are advantages and disadvantages of non-threaded posts

A
  • Advantages:
    • no stress on roots
  • Disadvantages:
    • less retention
31
Q

What are the advantages and disadvantages of threaded posts:

A
  • Advantages:
    • excellent retention
  • Disadvantages:
    • extreme stress on tooth structures
      • leads to root fracture
31
Q

Serrated Posts

A
  • bets of both worlds
  • passively fitted to canal
  • excellent retention
32
Q

Posts based on presence of thread

A

ed vs Non-threaded

  • Threaded posts:
    • tapped into the canal
  • Non-threaded posts:
    • passively fitted into the canal
    • only depend on cement
33
Q

Post Length

A
  • Longer the post the better the:
    • retention
    • load distribution
  • 6mm of apical gutta purcha is preferred
    • 3-5mm should be maintained
    • <3mm compromises the apical seal→Leakge→infection
34
Q

Post diameter

A
  • Be conservative
    • Thicker the post the thinner the dentin wall that is left
    • diameter should be enough to provide stiffness and strength
  • Ideal=1.75 mm of sound dentin around entire post
    • minimum=1mm
  • Increased diameter
    • increased strength
    • but not retention
35
Q

Post Adaptation:

A

Adaptation of the post to the canal and the thickness of the resin cement did not affect the retention

36
Q

Luting Agents

A
  • Available: Zinc phosphate, Glass Ionomer, Resin Modified Glass Ionomer, Resin Cement
  • Zinc Phosphate & Glass ionomer cements:
    • used because of long history of success and ease of manipulation
  • Resin Cement:
    • less leakage when used w/stainless-steel and carbon fiber posts vs zinc phosphate or glass ionomer cements
37
Q

Core Material

A
  • Amalgam and composite resin core:
    • distribute stress to the surface underneath the core
    • creates less cervical stress
  • Composite cores
    • fracture resistance comparable to amalgam and cast post and cores
    • but more favorable failure patterns when the fail

week 65 (6 decks)

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